Chylous ascites
Primary maldevelopment of the intra-abdominal lymphatic vessels
predisposes to disruption of lymphatic flow resulting in non-traumatic
leakage of chyle through intestinal villi into the abdominal cavity
resulting in chylous ascites. Chylous ascites typically presents with
abdominal distention and discomfort, clinical dehydration, malnutrition,
electrolyte imbalance, peripheral edema and immunosuppression.
Hypoproteinemia, specifically hypoalbuminemia, can cause decreased
vascular oncotic pressure and cause “third-spacing” soft tissue edema.
Congenital causes like intestinal lymphangiectasia or lymphatic
malformations demonstrate disrupted or dilated lymphatic vessels that
are prone to exudative leakage of lymphatic fluid through a fistula into
the peritoneum (Figure 1b) .[1] Steinmann et al reviewed 190
patients with chylous ascites noting 32% were caused by lymphatic
anomalies. Furthermore, 84% of these predominantly pediatric vascular
anomalies were classified as lymphangiectasia or Waldmann’s disease
(dilated lymphatic vessels that lack valves in the submucosa of the
small bowel).[8]
Paracentesis plays both a diagnostic and therapeutic role in the
management of chylous ascites. In the feeding child, chyle aspirated via
abdominal paracentesis appears milky white in appearance and biochemical
analysis demonstrates elevated triglyceride concentration
>110 mg/dl (similar to chylous effusions mentioned above).